Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Uptake of pre-exposure prophylaxis (PrEP) among Black individuals in the US is low and may be associated with limited availability of clinics where PrEP is prescribed. We investigated the association between spatial access and willingness to use PrEP. Objective: To determine the association between spatial access to clinics where pre-exposure prophylaxis (PrEP) is prescribed and willingness to use PrEP. Methods: We obtained locations of clinics where PrEP is prescribed from AIDSVu.org and calculated the density of PrEP clinics per 10,000 residents per ZIP Code. Individual-level data was obtained from the 2016 National Survey of HIV in the Black Community (NSHBC). We used multilevel modeling to estimate the association between willingness to use PrEP and clinic density among participants with individual-level (HIV risk, age, gender, education, income, insurance, doctor visit, census region, urban/rural residence), and ZIP-Code level (% poverty, % unemployed, % uninsured, % Black population, and density of health care facilities) variables. Results: All participants identified as Black/African-American. Forty-five percent of the 787 participants were male, 23% were high-risk, based upon self-reported behavioral characteristics. Their mean age was 34 years (SD=9), with 54% residing in the South, and 26% were willing to use PrEP. More than one-third (38%) of the sample had to drive more than one hour to access a PrEP provider. Participants living in areas with higher PrEP clinic density were significantly more willing to use PrEP [one standard deviation higher density of PrEP clinics per 10K population was associated with 16% higher willingness (APR=1.16, 95% CI=1.03, 1.31). Conclusions: Willingness to use PrEP is associated with spatial availability of clinics where providers prescribe PrEP in this nationally representative sample of Black Americans.